Surgical Reconstruction of Penile Urethral Strictures: Staged Procedures

  • Paurush Babbar
  • Hadley M. Wood
  • Kenneth W. AngermeierEmail author


Staged buccal mucosa graft urethroplasty has emerged as a reliable procedure for difficult penile urethral strictures not amenable to one-stage graft or flap reconstruction. It has primarily been used for strictures and/or fistulas associated with lichen sclerosis, obliterated urethra, or those occurring after previous surgery for hypospadias. Success rates in these patient populations have improved when compared to earlier techniques. It has nevertheless become clear that some patients will require more than two procedures to complete the reconstruction. However, based on recent experience there may be an opportunity to complete a higher percentage of these repairs in two operations using additional oral mucosa at the time of urethral tubularization. In addition, there are patients who will be content with their voiding pattern after the first operation and elect to forego second stage tubularization. Thorough preoperative evaluation and patient counseling are therefore critical in order to achieve successful surgical outcomes and avoid unnecessary graft harvest. In this chapter we review the surgical technique of contemporary staged urethroplasty for penile urethral stricture, and summarize previously published work.


Penile urethral stricture Staged procedures Urethroplasty Buccal mucosa graft Reconstructive urology 


  1. 1.
    Andrich DE, Greenwell TJ, Mundy AR. The problems of penile urethroplasty with particular reference to 2-stage reconstructions. J Urol. 2003;170(1):87–9.CrossRefGoogle Scholar
  2. 2.
    Barbagli G, De Angelis M, Palminteri E, et al. Failed hypospadias repair presenting in adults. Eur Urol. 2006;49:887–94.CrossRefGoogle Scholar
  3. 3.
    Bracka A. A versatile two-stage hypospadias repair. Br J Plast Surg. 1995;48(6):345–52.CrossRefGoogle Scholar
  4. 4.
    Carr LK, MacDiarmid SA, Webster GD. Treatment of complex anterior urethral stricture disease with mesh graft urethroplasty. J Urol. 1997;157(1):104–8.CrossRefGoogle Scholar
  5. 5.
    Figler BD, Gomella A, Hubbard L. Staged urethroplasty for penile urethral strictures from lichen sclerosus and failed hypospadias repair. Urology. 2018;112:222–4.CrossRefGoogle Scholar
  6. 6.
    Johanson B. The reconstruction in stenosis of the male urethra. Z Urol. 1953;46(6):361–75.PubMedGoogle Scholar
  7. 7.
    Kozinn SI, Harty NJ, Zinman L, Buckley JC. Management of complex anterior urethral strictures with multistage buccal mucosa graft reconstruction. Urology. 2013;82(3):718–22.CrossRefGoogle Scholar
  8. 8.
    Meeks JJ, Erickson BA, Gonzalez CM. Staged reconstruction of long segment urethral strictures in men with previous pediatric hypospadias repair. J Urol. 2009;181:685–9.CrossRefGoogle Scholar
  9. 9.
    Mori RL, Angermeier KW. Staged urethroplasty in the management of complex anterior urethral stricture disease. Transl Androl Urol. 2015;4(1):29–34.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Patel DP, Elliott SP, Voelzke BB, et al. Patient-reported sexual function after staged penile urethroplasty. Urology. 2015;86(2):395–400.CrossRefGoogle Scholar
  11. 11.
    Pfalzgraf D, Olianas R, Schreiter F, Fisch M. Two-staged urethroplasty: buccal mucosa and mesh graft techniques. Aktuelle Urol. 2010;41(Suppl 1):S5–9.CrossRefGoogle Scholar
  12. 12.
    Russell RH. The treatment of urethral stricture by excision. Br J Surg. 1914;2(7):375–83.CrossRefGoogle Scholar
  13. 13.
    Schreiter F. Mesh-graft urethroplasty: our experience with a new procedure. Eur Urol. 1984;10(5):338–44.CrossRefGoogle Scholar
  14. 14.
    Schreiter F, Noll F. Mesh graft urethroplasty using split thickness skin graft or foreskin. J Urol. 1989;142(5):1223–6.CrossRefGoogle Scholar
  15. 15.
    Spilotros M, Sihra N, Malde S, et al. Buccal mucosal graft urethroplasty in men-risk factors for recurrence and complications: a third referral centre experience in anterior urethroplasty using buccal mucosal graft. Transl Androl Urol. 2017;6(3):510–6.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Paurush Babbar
    • 1
  • Hadley M. Wood
    • 1
  • Kenneth W. Angermeier
    • 1
    Email author
  1. 1.Center for Genitourinary Reconstruction, Glickman Urological and Kidney InstituteCleveland ClinicClevelandUSA

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